Utilization of Subsidized Transportation Services Improves Wound Healing and Care Coordination in a Limb Preservation...

We aimed to compare wound healing rates and amputation-free survival among patients with personal transportation to those that utilized transportation services (TS) as part of a limb preservation program (LPP).

Patients who required lower extremity wound care appointments from June 2021 to February 2023 were enrolled in the program and offered subsidized transportation. Like-patient controls to those who qualified for TS were identified utilizing propensity-score matching from January, 2019 to May, 2021. Primary outcomes between all groups include wound healing rates and amputation-free survival.

Of 138 patients enrolled in the LPP, 40 (30.0%) required some form of TS. Patients who required services were more likely to be non-Hispanic black, have public insurance, and live in an area with a higher area deprivation index compared to independent patients. Despite this, wound characteristics were similar between groups, including wound location and WIfI scores. Rates of wound healing (57.5 vs. 63.3%), major amputation-free survival (95.9 vs. 89.8%), and new ulcer development (22.5 vs. 17.3%) were all similar between groups (all P > 0.05). In subgroup analysis, those who would have qualified for TS had higher frequency of new ulcer development (43.8 vs. 22.5%, P = 0.023) and major amputation (12.5 vs. 5.0%, P = 0.005).

TS were utilized by patients with less access to care yet allowed for equivalent wound healing to patients with personal transportation. Compared to a cohort of patients before TS were offered, patients who required TS had improved wound healing and care coordination preventing wound regression. This study highlights the role that these interventions can play in improving lower extremity outcomes among disadvantaged patients.